Rural area in a European country from a health care point of view: an adaption of the Rural Ranking Scale

BMC Health Services Research

Stefanie Joos²  Joachim Szecsenyi²  Katja Goetz²  Petra Otto¹  Jost Steinhaeuser² 

[1]Department of General Practice and Health Services Research, University Hospital Heidelberg, Vossstrasse 2, Heidelberg 69115, Germany

[2]Competence Centre General Practice Baden-Wuerttemberg, Vossstrasse 2, Heidelberg 69115, Germany

关键词: Rural area;    Physician shortage;    Knowledge transfer;    Health service research;    Family medicine;   

Others  :  1133024
DOI  :  10.1186/1472-6963-14-147

 received in 2013-06-25, accepted in 2014-03-26,  发布年份 2014

【 摘 要 】

Background

In many countries, rural areas are facing a shortage of general practitioners (GPs). Appropriate strategies to address this challenge are needed. From a health care delivery point of view, the term rural area is often poorly defined. However rural areas have to be adequately defined to ensure specific strategies are tailored to these environments. The aims of this study were to translate the New Zealand 6-item Rural Ranking Scale (RRS), to culturally adapt it and to implement it to identify rural areas from a health care delivery perspective. Therefore we aimed to validate the RRS by defining cut-off scores for urban, semi-rural and rural areas in Germany.

Methods

After receiving permission, two researchers independently translated the RRS. In a consensus meeting, four items were identified that had to be culturally adapted. The modified RRS-Germany (mRRS-G) was sent to 724 GPs located in urban, semi-rural and rural areas to validate the “rurality” scoring system for conditions in Germany.

Results

Four items, “travelling time to next major hospital”, “on-call duty”, “regular peripheral clinic” and “on-call for major traumas” had to be adapted due to differences in the health care system. The survey had a response rate of 33.7%. A factor analysis showed a three dimensional structure of the mRRS-G scale with a poor internal consistency. Nevertheless, the three items regarding “on-call duty”, “next major hospital” and “most distant boundary covered by your practice” were identified as significant predictors for rurality. The adapted cut-off point for rurality in Germany was 16. From this study’s participants, 9 met the RRS cut-off point for rurality (a score of 35 or more).

Conclusion

Compared with New Zealand rurality scores based on this tool, German scores are far less rural from a health care delivery point of view. We consider that the construct of rurality has more aspects than those assessed by the mRRS-G. Nevertheless, rural areas from a health care delivery viewpoint can be effectively defined using mRRS-G and therefore it can support tailored strategies against GPs shortage.

【 授权许可】

   
2014 Steinhaeuser et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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【 参考文献 】

• [1]Colwill JM, Cultice JM, Kruse RL: Will generalist physician supply meet demands of an increasing and aging population? Health Affairs (Millwood) 2008, 27:232-241.
• [2]Hann M, Gravelle H: The maldistribution of general practitioners in England and Wales: 1974–2003. Br J Gen Pract 2004, 54:894-898.
• [3]Bodenheimer T, Pham HH: Primary care: current problems and proposed solutions. Health Affairs (Millwood) 2010, 29:799-805.
• [4]Sibbald B: Putting General Practitioners Where they are Needed: An Overview of Strategies to Correct Maldistribution. National Primary Care research and Development Centre: University of Manchester; 2005. http://www.population-health.manchester.ac.uk/primarycare/npcrdc-archive/Publications/overview%20of%20strategies%20to%20correct%20maldistribution.pdf webcite
• [5]Bourke L, Taylor J, Humphreys JS, Wakerman J: "Rural health is subjective, everyone sees it differently": Understandings of rural health among Australian stakeholders. Health Place 2013, 24:65-72. Epub 2013 Aug 26
• [6]Landy DC, Gorin MA, Egusquiza JD, Weiss J, O‘Connell MT: Medical student attitudes before and after participation in rural health fairs. J Res Med Sci 2012, 3:298-303.
• [7]Stagg P, Greenhill J, Worley PS: A new model to understand the career choice and practice location decisions of medical graduates. Rural Rem Health 2009, 9:1245. Epub 2009 Nov 28
• [8]Du Plessis V, Beshiri R, Bollmann RD, Clemenson H: Definitions of “Rural”. Ottawa: Statistics Canada; 2002. [Agriculture and Rural Working Paper Series Working Paper No.61]
• [9]Swan GM, Selvaraj S, Godden DJ: Clinical peripherality: development of a peripherality index for rural health services. BMC Health Serv Res 2008, 8:23. BioMed Central Full Text
• [10]Organisation for Economic Co-operation and Development (OECD): Creating Rural Indicators for Shaping Territorial Policy. Paris: OECD; 1994.
• [11]Steinhäuser J, Scheidt L, Szecsenyi J, Götz K, Joos S: Perceptions of the Local Government about the Primary Care Physicians Shortage - A Survey among Mayors in the Federal State of Baden-Wuerttemberg [Article in German]. Das Gesundheitswesen 2012, 74:612-617.
• [12]Kopetsch T: The German Health Care System Is Running out of Physicians! A study about the Structure of the Age and Trend of the Number of Physicians. Berlin: Bundesärztekammer und Kassenärztliche Bundesvereinigung; 2010. http://www.bundesaerztekammer.de/downloads/Arztzahlstudie_03092010.pdf webcite
• [13]The Federal Institute for Research on Building. Urban Affairs and Spatial Development http://178.63.99.250/raumbeobachtung/ webcite
• [14]Baden-Wuerttemberg Ministry of Rural Area, Alimentation and Consumer Protection Stuttgart, Germany http://www.mlr.baden-wuerttemberg.de/Laendlicher_Raum/68691.html webcite
• [15]Bourke L, Sheridan C, Russell U, Jones G, DeWitt D, Liaw ST: Developing a conceptual understanding of rural health practice. Aust J Rural Health 2004, 12:181-186.
• [16]Steinhaeuser J, Joos S, Szecsenyi J, Miksch A: A comparison of the workload of rural and urban primary care physicians in Germany: analysis of a questionnaire survey. BMC Fam Pract 2011, 12:112. BioMed Central Full Text
• [17]Leduc E: Defining rurality: a General Practice Rurality Index for Canada. Can J Rural Med 1997, 2:125.
• [18]Steinhäuser J, Annan N, Roos M, Szecsenyi J, Joos S: Approaches to reduce shortage of general practitioners in rural areas–results of an online survey of trainee doctors [in German]. Dtsch Med Wochenschr 2011, 136:1715-1719.
• [19]Janes R, Dowell A, Cormack D: New Zealand Rural General Practitioners 1999 Survey - Part 1: An overview of the rural doctor workforce and their concerns. New Zeal Med J 2001, 114:492-495.
• [20]Wild D, Grove A, Martin M, Eremenco S, McElroy S, Verjee-Lorenz A, Erikson P: Principles of good practice for the translation and cultural adaptation process for Patient-Reported Outcomes (PRO) measures: report of the ISPOR Task Force for Translation and Cultural Adaptation. Value Health 2005, 8:94-104.
• [21]Cronbach LJ: Coefficient alpha and the internal structure of tests. Psychometrika 1951, 16:297-334.
• [22]OECD: Health at a Glance 2011 OECD Indicators. http://www.oecd-ilibrary.org/social-issues-migration-health/health-at-a-glance-2011_health_glance-2011-en webcite
• [23]Henry JA, Edwards BJ, Crotty B: Why do medical graduates choose rural careers? Rural Rem Health 2009, 1083:1347.
• [24]Ranmuthugala G, Humphreys J, Solarsh B, Walters L, Worley P, Wakerman J, Dunbar JA, Solarsh G: Where is the evidence that rural exposure increases uptake of rural medical practice? Aust J Rural Health 2007, 15:285-288.
• [25]Steinhäuser J, Joos S: Strategies against the physician shortage: Doc meets rural area – the “Rural days“ oft the Verbundweiterbildung plus [article in German]. BWGZ 2012, 20:856-857.
• [26]Roick C, Heider D, Günther OH, Kürstein B, Riedel-Heller SG, König HH: Factors influencing the decision to establish a primary care practice: results from a postal survey of young physicians in Germany. Das Gesundheitswesen 2012, 74:12-20. doi: 10.1055/s-0030-1268448. Epub 2010 Dec 15
• [27]Natanzon I, Szecsenyi J, Ose D, Joos S: Future potential country doctor: the perspectives of German GPs. Rural Rem Health 2010, 10:1347. Epub 2010 May 7